Incomplete Intervention Description, Incorrect Exploratory Outcome Data, and Incorrect Axis Labels
In the Original Investigation titled “Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial” published in the October 15, 2019, issue of JAMA, one of the interventions was incompletel y described in the Abstract and Methods section. It should have specified that patients received either high-flow nasal oxygen alone or high-flow nasal oxygen alternating with noninvasive ventilation. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Issues and Questions Surrounding Screening for Cognitive Impairment in Older Patients
The importance of addressing age-associated cognitive impairment cannot be overstated. The rising prevalence of cognitive impairment such as mild cognitive impairment (MCI) and dementia, including Alzheimer disease, is becoming a worldwide concern. In this issue of JAMA, the US Preventive Services Task Force (USPSTF) concludes that “the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults (I statement).” This recommendation is based on an evidence report and systematic review of the literature that assessed the accuracy of cognitive s...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Abbreviated MRI Protocol for Breast Cancer Screening in Women With Dense Breasts
Few areas of medicine have been as controversial and emotionally charged as breast cancer screening. Although mammography screening is a mainstay of preventive health care for women in the United States, the limitations of mammography for detecting breast cancer among women with mammographically dense breasts have received increasing attention from both advocacy groups and the medical community. Currently, legislation addressing communication regarding breast density is in place for a majority of states (38 states and the District of Columbia), and a federal law mandates that the US Food and Drug Administration advance min...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Alcohol-Related Mortality Increases May Still Underestimate the Toll
The number of US death certificates that cited alcohol involvement more than doubled from 1999 to 2017, according to a recent study by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Federal Nutrition Programs Need Stronger Focus on Older Adults
The US Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA) fall short in ensuring that nutrition assistance programs for older adults meet their nutritional needs, according to a recent Government Accountability Office (GAO) report. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

HHS Funds Development of Antibiotic to Treat Anthrax
The US Department of Health and Human Services (HHS) recently issued the first Project BioShield contract to fund research to support the use of an existing antibiotic to treat inhalational anthrax exposure. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Moving to Action on Place-Based Health
Since the English physician John Snow first mapped London ’s cholera outbreak to a local water pump in the 1850s, it has been understood that a community’s design affects the health of its inhabitants. Present-day research continues to support a dominant role for place-based factors in generating health outcomes, but investment in local drivers of heal th has not kept pace with our understanding of their outsize influence on morbidity and mortality. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Senescence, Senility and Crime
The relation between age and crime is significant socially. East emphasizes that most magistrates are not appointed until they have reached middle age; this preponderance of middle age and elderly judges, he feels, may be far from desirable in cases involving juvenile crime. East quotes a circular in 1936 which declared that, “apart from the obvious advantages attaching to quickness of hearing and of sight in a justice, there is the fact that as time goes on men and women justices are apt to lose the freshness of mind and sympathy and the up to date knowledge of social conditions which are of extreme importance for s...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Major Adverse Cardiovascular Events After 12 Months Among Patients With ACS Receiving Atorvastatin Prior to Planned PCI
This study uses SECURE-PCI trial data to compare the effects of periprocedural loading doses of atorvastatin vs placebo on major adverse cardiac events (MACE) 12 months after randomization in patients with acute coronary syndrome (ACS) and planned invasive management. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

N95 Respirators vs Medical Masks in Outpatient Settings
To the Editor In a pragmatic effectiveness study among outpatient health care personnel, Dr Radonovich and colleagues reported that use of N95 respirators vs medical masks “as worn by participants” resulted in no significant difference in the incidence of laboratory-confirmed influenza between the groups. An accompanying editorial suggested that the study findings can be generalized and used by hospital epidemiologists to argue against the use of respirators for p rotection of health care workers in outpatient settings against all respiratory viruses. However, the study has limitations—principally, the ex...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Vitamin C for Sepsis and Acute Respiratory Failure
To the Editor As ever more critical care trials fail to demonstrate a mortality effect, we believe that randomized trials can be made more efficient and informative by the careful choice of a disease-oriented end point rather than mortality. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Vitamin C for Sepsis and Acute Respiratory Failure
To the Editor The CITRIS-ALI trial revealed no difference in the primary outcomes of organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure randomized to intravenous infusions of vitamin C or placebo. However, unadjusted analyses of predefined secondary outcomes suggested a possible benefit of high-dose intravenous vitamin C on mortality. Given that a before-and-after study suggested a mortality benefit among patients with sepsis receiving intravenous vitamin C, thiamine, and hydrocortisone, we believe the differences in mortality observed in the CITRIS...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Obsessive-Compulsive Behaviors in Autism
To the Editor A randomized clinical trial examined the use of fluoxetine compared with placebo among autistic children and adolescents. It represents an important interrogation of common off-label prescribing practices that neglect potential risks. Nonetheless, we are concerned by the use of a potentially flawed primary outcome measure. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

N95 Respirators vs Medical Masks in Outpatient Settings —Reply
In Reply Dr McDiarmid and colleagues comment on the design and conduct of our study, the Respiratory Protection Effectiveness Clinical Trial (ResPECT). They note, and we agree, that a number of laboratory and simulated workplace studies have shown respirators to have superior performance compared with medical masks; however, the results of clinical trials have not been definitive. The complexities of delivering health care introduce behavioral factors that may influence the effectiveness of infection prevention measures, including adherence to procedures that have been shown in laboratory settings to optimize efficacy. Res...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Vitamin C for Sepsis and Acute Respiratory Failure —Reply
In Reply Dr Hager and colleagues raise 2 important issues regarding use of high-dose intravenous vitamin C: recognition of hypoglycemia and factitious hyperglycemia that may lead to inappropriate use of insulin. Bedside point-of-care glucose measurements have emerged as the standard of care in many intensive care units, and these devices will record false elevations of blood glucose as intravenous infusion of vitamin C leads to high plasma levels. Using point-of-care devices in patients receiving intravenous vitamin C prevents recognition of hypoglycemia and may lead to inappropriate use of insulin. Interference with devic...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Obsessive-Compulsive Behaviors in Autism —Reply
In Reply Mr Ne ’eman and colleagues raise important points regarding the use of the CYBOCS-PDD in our study. Our trial aimed to investigate a biological concept and provide evidence as to whether fluoxetine could reduce obsessive-compulsive behaviors in children and adolescents with autism spectrum disorders. Cl inicians regularly use these medications, and a Cochrane review had called for proof of their efficacy. The aim was to extend the evidence base and ultimately improve the care of young people with autism spectrum disorders. The CYBOCS-PDD was chosen because of its use in previous studies and evidenc e in this...
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Sublingual Apomorphine Manages Parkinson Disease Off Episodes
Apomorphine sublingual film effectively treated Parkinson disease off-episodes among patients who tolerated the therapy, a multisite trial in The Lancet Neurology reported. The sublingual film is an investigational formulation of apomorphine, an approved Parkinson therapy given by injection. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Alcohol Abstinence Lowers Atrial Fibrillation Recurrence Risk
Regular drinkers with atrial fibrillation who drastically reduced their alcohol consumption had fewer arrhythmia recurrences, a multicenter Australian trial published in the New England Journal of Medicine found. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Platelet-Rich Plasma Doesn ’t Facilitate Achilles Tendon Healing
Platelet-rich plasma provided no benefit after acute Achilles tendon rupture, a trial in the BMJ reported. The autologous whole-blood product, which delivers a high concentration of platelets, leucocytes, growth factors, and cytokines, is used extensively in sports and orthopedic medicine. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Anti-IgE Medication Lessens Pediatric Atopic Dermatitis Severity
Omalizumab, an anti-IgE medication approved to treat asthma and hives, significantly reduced children ’s atopic dermatitis severity and improved their quality of life, according to a trial in JAMA Pediatrics. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Novel Drug Benefits Bone and Cartilage in Knee Osteoarthritis
An investigational selective cathepsin K inhibitor called MIV-711 failed to decrease knee osteoarthritis pain but attenuated bone area progression and reduced cartilage volume loss, a multicenter European trial reported in the Annals of Internal Medicine. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection in Women With Dense Breasts
This randomized trial compares the accuracy of screening with abbreviated breast magnetic resonance imaging (MRI) vs digital breast tomosynthesis (DBT) on invasive breast cancer detection rates in women with dense breasts. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Screening for Cognitive Impairment in Older Adults
This JAMA Patient Page describes recent US Preventive Services Task Force recommendations on screening for cognitive impairments in older adults. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

My First Mammogram
My shadow has darted behind the cold antiseptic wall – and humming machines, not wanting to be seen. My first time in the decorative parlor smelling of alcohol and nurses’ white rubbery shoes, no perfume allowed. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Tiny Branches —Words That Bring Hope
In this narrative medicine essay, an internist traces the vicissitudes of hope and despair during his wife ’s long battle with breast cancer and highlights how encouraging words from nontreating physicians serve as branches of hope that communicate an unpredictable prognosis. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

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(Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

USPSTF Report: Screening for Cognitive Impairment in Older Adults
This systematic review to support the 2020 US Preventive Services Task Force Recommendation Statement on screening for cognitive impairment in older adults summarizes published evidence on the benefits and harms of cognitive impairment screening and treatment in adults 65 years or older. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

USPSTF Recommendation: Screening for Cognitive Impairment in Older Adults
This 2020 Recommendation Statement from the US Preventive Services Task Force concludes that current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in adults 65 years or older (I statement). (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Multidrug-Resistant Candida auris Concern Stems From New York Cases
Although multidrug-resistant Candida auris infections are rare, New York health officials advise close monitoring of cases after 3 patients in the state were found to have C auris that was resistant to all 3 classes of commonly prescribed antifungal drugs (pan resistance). (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Fewer Opioids Prescribed for Pain at Emergency Department Discharge
Opioid prescribing for patients discharged from the emergency department has followed a national downward trend in recent years, according to a CDC report. (Source: JAMA)
Source: JAMA - February 25, 2020 Category: General Medicine Source Type: research

Incorrect Data in Text
In the US Preventive Services Task Force (USPSTF) Recommendation Statement entitled “Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement” published in the November 15, 2016, issue of JAMA, incorrect data were reported in the text. In the first paragraph of the “Statin Use in Adults Aged 40 to 75 Years” subsection and in the third paragraph of the “Benefits of Statin Use” subsection, the text “RR, 0.69 [95% CI, 0.54-0.88]” should have read “RR, 0.82 [95% CI, 0.71-0.94].” The certainty...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Incorrect Data in Text, Table, Figure, and Supplement
This article was corrected online. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Incorrect Data in Text
This article was corrected online. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Incorrect Percent Values Reported in Text and Table 1
This article was corrected online. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Polygenic Risk Scores for Coronary Artery Disease?
A risk-based prevention strategy is the most widely accepted approach to guide clinician-patient decision-making for prevention of coronary artery disease (CAD). According to this approach, the intensity of prevention efforts is matched to the estimated risk of the individual. American College of Cardiology/American Heart Association guidelines currently recommend pooled cohort equations for initial risk assessment, which integrate age, systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking status, and treatment for hypertension and diabetes to provide race- and sex-specific estimates of ...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Drug Approved for Rare Mutation in Gastrointestinal Tumor
The FDA has approved a tyrosine kinase inhibitor to treat adults with an unresectable or metastatic gastrointestinal stromal tumor (GIST) that has a specific genetic mutation. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

FDA Says It Supports Cannabis Drug Development via Regulatory Pathways
A key FDA official told members of Congress last month that the agency supports the development of new drugs that contain cannabis or are derived from the plant. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

FDA Assesses Potential Cancer Risk Associated With Weight Loss Drug
A recent drug safety communication alerted health professionals and the public about a potential increased risk of cancer associated with the weight management medication lorcaserin. The FDA has advised clinicians to consider whether the drug ’s benefits outweigh its potential risks when deciding to prescribe or continue prescribing it. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Book Notices
Contributions to Medical and Biological Research. Dedicated to Sir William Osler, Bart., M.D., F.R.S., in honor of his seventieth birthday, July 12, 1919, by his pupils and co-workers. Two volumes. Pp. 1268. Paul B. Hoeber, New York. Edition limited to 1,600 copies. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Private Equity Acquisitions of Physician Medical Groups Across Specialties, 2013-2016
This study characterizes practice characteristics and specialties of physicians and medical groups acquired by private equity firms between 2013 and 2016. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Selepressin for Patients With Septic Shock
To the Editor Compared with placebo, the nonadrenergic vasopressor angiotensin II was shown to increase mean arterial pressure after 3 hours in patients with vasodilatory shock in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) trial (primary end point). In addition, angiotensin II also reached the secondary goal of a greater reduction in the cardiovascular Sequential Organ Failure Assessment (SOFA) score after 48 hours vs placebo. As a consequence, research with angiotensin II continued and it was approved by the US Food and Drug Administration. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Unmeasured Confounding in Observational Studies of Management of Cerebellar Intracranial Hemorrhage
To the Editor In a propensity score –matched cohort of 578 patients from 4 observational cohort studies, Dr Kuramatsu and colleagues showed that evacuation of medium-sized intracerebellar hematomas (approximate volume, 20 cm3) was not associated with better functional outcome. Assessing treatment effectiveness in observational data is challenging because treatment decisions are based on patient characteristics that also are typically predictive of outcome, causing confounding by indication. Although the authors addressed this potential bias with propensity scores, we would like to emphasize the possibility of residua...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Risk of Offspring Birth Defects in Women After Bariatric Surgery
To the Editor In a Research Letter, Dr Neovius and colleagues investigated the association between gastric bypass surgery and risk of birth defects in offspring. The authors found that bariatric surgery was protective against birth defects. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Error in USPSTF Report on Statin Use
The 2016 review for the US Preventive Services Task Force on statins for prevention of cardiovascular disease in adults had errors in the analysis of statins vs placebo and cardiovascular mortality. For the JUPITER trial, we interpreted “MI, stroke or cardiovascular death” as reported in the main trial publication as “myocardial death, stroke death, or cardiovascular death,” when it meant “nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.” Therefore, the analysis erroneously included nonfatal myo cardial infarction and stroke events (83/8901 vs 157/8901 in the ros...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Unmeasured Confounding in Observational Studies of Management of Cerebellar Intracranial Hemorrhage —Reply
In Reply We agree with Dr van Essen and colleagues that observational studies harbor the risk of unmeasured confounding. Treatment of patients with intracerebral hemorrhage has been studied in only a few trials with considerable variance in management protocols. Hence, large multicenter observational studies must be relied on to provide treatment estimates. To address the limitation of unmeasured confounding, we compared our study results (propensity score –matched analysis) with instrumental variable analysis, which is potentially more resilient to unmeasured confounding, as suggested by van Essen and colleagues. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Selepressin for Patients With Septic Shock —Reply
In Reply We agree with Dr Rehberg and colleagues that our study demonstrated that selepressin had a number of advantageous physiologic effects on blood pressure, urine output, and other features associated with septic shock. In this way, as the authors suggest, it appears that selepressin shares a set of properties similar to that of other agents used for cardiovascular support in septic shock, including the recently approved angiotensin II. In contrast to the study on which angiotensin II was approved, we chose a primary outcome designed to determine whether care with selepressin improved downstream patient-centered outco...
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Risk of Offspring Birth Defects in Women After Bariatric Surgery —Reply
In Reply We agree with Dr Auger and colleagues that there are several effects of gastric bypass surgery that may influence the risk of birth defects, including positive effects from weight loss and improved glucose control, as well as negative effects such as nutrient deficiencies and increased risk of substance abuse. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research

Predictive Accuracy of a Polygenic Risk Score Compared With a Clinical Risk Score for Incident Coronary Heart Disease
This pooled cohort involving US adults with white European ancestry compares the accuracy of a polygenic risk score vs 2013 ACC/AHA pooled cohort equations for predicting 10-year risk of coronary heart disease. (Source: JAMA)
Source: JAMA - February 18, 2020 Category: General Medicine Source Type: research